Billing and Coding: CPT® Modifier 59: Gastroenterology

CPT modifier 59 is appropriate only when two procedures/services that are ordinarily bundled are truly distinct — most commonly because they were performed at different anatomic sites (different organs or separate lesions), at separate patient encounters/sessions, or involved separate incisions/excisions or distinct areas of injury. Modifier 59 must not be used if a more specific NCCI-associated modifier applies, to bypass NCCI edits, or when procedures occur at the same anatomic site or same encounter; documentation in the medical record must clearly support the rationale for modifier 59.

"Append CPT modifier 59 when two or more procedures/services that are not normally reported together are performed at different anatomic sites (different organs or different lesions within the same ..."

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